title: Induction therapy in adult intestinal transplantation: reduced incidence of rejection with "2-dose" alemtuzumab protocol.
abstract: The incidence of early rejection after intestinal transplantation correlates with heightened risk of graft loss and mortality. Many different induction or pre-conditioning protocols have been reported in the last 10 yr to improve outcomes; however, sepsis remains prevalent and diminishes long-term results. We recently began a "2-dose" alemtuzumab trial protocol - 15 mg at day 0 and 15 mg repeated on day 7 - with the hope of reducing our infection rate. We compared three different protocols used at our institution (daclizumab, conventional "4-dose" alemtuzumab, and "2-dose" alemtuzumab). There was a significantly lower rate of early rejection with the "2-dose" alemtuzumab protocol in our study group of mainly (88%) intestinal grafts without accompanying liver engraftment with its protective immunologic effect. Sepsis remained low. Longer follow-up will be required to evaluate the effects of this new protocol on longer-term outcomes.
authors.affiliation: Liver and Multiorgan Transplant Center, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Lauro
authors.forename: C
authors.initials: C
authors.lastname: Zanfi
authors.forename: A
authors.initials: A
authors.lastname: Bagni
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: A
authors.initials: A
authors.lastname: Siniscalchi
authors.forename: S
authors.initials: S
authors.lastname: Pellegrini
authors.forename: L
authors.initials: L
authors.lastname: Pironi
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007421:Intestine, Small / Q000637:transplantation*; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction; D015996:Survival Rate; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000074323:Alemtuzumab
keywords: acute cellular rejection; alemtuzumab; induction